Osteoarthritis (OA) is an inflammatory disease of the joints. Damage to the articular cartilage, synovial lining, bones and surrounding joint ligaments causes pain and swelling; and subsequently leads to changes in joint movement and overall function. OA is a progressive disease and over time bones may further degenerate and/or develop bony spurs. There is also an inflammatory component to OA, whereby cytokines (inflammatory chemicals) and enzymes develop and cause further damage to the articular cartilage. In late stage OA, the articular cartilage wears away and the two opposing joint surfaces rub against each other causing further joint damage and pain.
Who is Affected:
OA can occur in people of all ages. However, it is most common in people over 65 years of age
50% of adults will develop symptoms of knee OA
25% of adults will develop symptoms of hip OA by age 85
8% of adults will develop symptoms of hand OA by age 60
Risk Factors:
Increasing age
Obesity - being overweight puts additional load through the joints, particularly hips and knees - increased load causes the surfaces to degenerate faster, leading to earlier OA - increased body fat accumulation increases the production of cytokines, which can further increase the rate of cartilage degeneration - increased rate of degeneration increases the requirement of joint replacement surgery
Previous joint injury or overuse of the joint - repetitive movements or injuries can lead to quicker joint degeneration
Weak surrounding musculature - imbalances or weaknesses of muscles around a joint create a malalignment of the joint surfaces - repetitive joint movement in a malaligned position can create increased localised wear on one area of the joint, subsequently encouraging further malalignment, perpetuating the cycle of ongoing degeneration
Genetic predisposition - a rare defect in the body’s ability to produce collagen, which is the protein that makes up cartilage. In this case, OA can abnormally develop as early as age 20. - inherited traits of joint depth and alignment can lead to the cartilage wearing away faster than usual
Diagnosis:
OA may be suspected from a detailed medical history and recount of symptoms. OA will often be confirmed with an x-ray or MRI as they can show the extent of joint space narrowing; presence of bony spurs; and cartilage degeneration.
Treatment:
Conservative management of OA is recommended to improve the symptoms of OA, as well as for overall health. Exercise has been shown to reduce pain associated with OA as well as improving overall joint function, which ultimately leads to the increased ability to perform activities of daily living. Exercise can also assist with the prevention and reduction of excess body fat, which reduces the load through the joints and decreases the wear of the joint surfaces, as well as reducing the production of inflammatory chemicals. Early exercise intervention can decrease the progression of OA and avoid or delay the necessity of joint replacement surgery.
Exercise Guidelines:
Frequency: 3-4 times per week
Intensity: approximately 60-70% HR max; RPE of 6-7/10 - enough effort to generate some “puffing”, but still with the ability to speak in full sentences
Time (in target intensity zone): 10-15 minutes (beginner) --> 30-45 minutes as tolerated
Type of exercise: Full body exercise, using large muscle groups - walking; swimming; cycling for aerobic focus - resistance/weighted exercise for increasing muscle strength and bulk - as OA in joints of the lower limb is highly correlated to impaired balance and a subsequent high falls risk, targeted balance retraining is beneficial
If you or someone you know would benefit from a joint pain assessment, book an appointment with one of our physiotherapists to have a targeted exercise plan developed. Body Plus Health also runs Strength and Conditioning classes for people of all ages, injuries and conditions - book your spot and exercise in a safe and supervised environment!
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